Provider Demographics
NPI:1518120047
Name:DIETZ, CRAIG E (DMD)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:E
Last Name:DIETZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2742
Mailing Address - Street 2:
Mailing Address - City:EAST LIVERPOOL
Mailing Address - State:OH
Mailing Address - Zip Code:43920-0742
Mailing Address - Country:US
Mailing Address - Phone:330-385-6216
Mailing Address - Fax:330-385-0716
Practice Address - Street 1:48853 CALCUTTA SMITH FERRY RD
Practice Address - Street 2:
Practice Address - City:EAST LIVERPOOL
Practice Address - State:OH
Practice Address - Zip Code:43920-9639
Practice Address - Country:US
Practice Address - Phone:330-385-6216
Practice Address - Fax:330-385-0716
Is Sole Proprietor?:No
Enumeration Date:2008-07-03
Last Update Date:2020-05-06
Deactivation Date:2020-04-16
Deactivation Code:
Reactivation Date:2020-05-06
Provider Licenses
StateLicense IDTaxonomies
OH168901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice